What should be checked in the review of claims before submission?

• A. Ensure accuracy of patient and insured information, attachments, and that the diagnosis is coded correctly.
• B. Verify only the patient's name.
• C. Confirm the provider's license number only.
• D. Check the email address for submission.

Answer: (A)

Before submitting a claim, you should verify patient and insured information for accuracy, ensure all required attachments are included, and confirm the diagnosis is coded correctly. Accurate demographics and insurance details prevent misbilling, eligibility holds, or claim edits that delay payment. Attachments provide the necessary documentation to support medical necessity and the chosen codes, reducing denial risk. Correct diagnosis coding means the ICD-10-CM codes accurately reflect the clinician’s documented condition and align with the CPT/HCPCS services billed, which is essential for proper reimbursement and compliance with coding guidelines. Focusing on only one small element, like just the patient’s name, or a single item such as the provider’s license number or an email address, misses other critical aspects and is more likely to lead to denied or delayed claims.